Detection of pregnancies with high risk of fetal macrosomia among women with gestational diabetes mellitus.

Abstract

OBJECTIVE:

To compare the frequency of fetal macrosomia and Erb's palsy in two groups of women with gestational diabetes mellitus (GDM) and in healthy controls.

DESIGN:

Retrospective clinical study of women with GDM.

SETTING:

Pregnant women in Greater Helsinki area.

POPULATION:

Nine hundred and five pregnancies and newborn infants of women with GDM and 805 non-diabetic controls.

METHODS:

GDM was diagnosed by a 2-hour oral glucose tolerance test (OGTT) among women with risk factors for GDM. The treatment of GDM was resolved by a 24-hour glucose profile obtained after 2 or 3 abnormal glucose values in the OGTT. Patients with a history of insulin-treated GDM in a previous pregnancy and those with a fasting glucose over 6 mmol/l underwent a 24-h glucose profile directly without a preceding OGTT.

MAIN OUTCOME MEASURES:

Fetal macrosomia, defined as a birth weight (adjusted for sex and gestational age) of >2.0 SD above the mean of a Finnish standard population. Erb's palsy.

RESULTS:

385 women (42.5%) were treated with insulin and diet and 520 (57.5%) with diet only. Macrosomia occurred more often in the insulin-treated group (18.2%, p<0.001) compared with the diet-treated group (4.4%) and the controls (2.2%). The rate of Erb's palsy was 2.7% in the insulin-treated group, 2.4% in the diet-treated group, compared with 0.3% in the controls (p<0.001).

CONCLUSION:

The 24-hour glucose profile performed after the diagnosis of GDM clearly distinguishes between low-risk (diet-treated) and high-risk (insulin-treated) for fetal macrosomia in GDM pregnancies.

• Authors: Lauri Suhonen, Vilho Hiilesmaa, Risto Kaaja, Kari Teramo
• Journal: Acta obstetricia et gynecologica Scandinavica (Acta Obstet Gynecol Scand) Vol. 87 Issue 9 Pg. 940-5 ( 2008) ISSN: 1600-0412 [Electronic] United States
• PMID: 18728914 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Insulin

Topics

• Adult
• Birth Weight
• Brachial Plexus Neuropathies (epidemiology)
• Case-Control Studies
• Diabetes, Gestational (blood, drug therapy, epidemiology)
• Female
• Fetal Macrosomia (epidemiology)
• Finland (epidemiology)
• Glucose Tolerance Test
• Humans
• Infant, Newborn
• Insulin (administration & dosage)
• Logistic Models
• Male
• Pregnancy
• Retrospective Studies
• Risk Factors